Cipro

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Cipro

Cipro is a broad spectrum antimicrobial agent. It acts bactericidal on gram-negative organisms during rest and division. It treats uncomplicated and complicated infections caused by microorganisms predisposed to ciprofloxacin.

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Cipro (ciprofloxacin) is a quinolone antibiotic used to treat a number of bacterial infections.

How does it work?

Cipro is a broad-spectrum antimicrobial drug from the group of fluoroquinolones. It has a bactericidal effect. The drug inhibits the enzyme DNA gyrase of bacteria, as a result of which DNA replication and the synthesis of bacterial cellular proteins are disrupted. Ciprofloxacin acts both on multiplying microorganisms and on those in the resting phase.

When is Cipro used?

Infectious and inflammatory diseases caused by sensitive microorganisms: lower respiratory tract infections (acute bronchitis and chronic bronchitis in the acute stage, pneumonia, bronchiectasis, infectious complications of cystic fibrosis); ENT infections (acute sinusitis); infections of the kidneys and urinary tract (cystitis, pyelonephritis); complicated intra-abdominal infections (in combination with metronidazole); chronic bacterial prostatitis; uncomplicated gonorrhea; typhoid fever, campylobacteriosis, shigellosis, travelers’ diarrhea; infections of the skin and soft tissues (infected ulcers, wounds, burns, abscesses, phlegmon); infections of bones and joints (osteomyelitis, septic arthritis); infections against the background of immunodeficiency (arising from treatment with immunosuppressive drugs or in patients with neutropenia); prevention and treatment of pulmonary anthrax;

Children over 6 years: prevention and treatment of pulmonary anthrax (Bacillus anthracis infection).

What bacteria kills Cipro?

Gram-negative aerobic bacteria are susceptible to ciprofloxacin: Enterobacteriaceae (Escherichia coli, Salmonella spp., Shigella spp., Citrobacter spp., Klebsiella spp., Enterobacter spp., Proteus mirabilis, Proteus alwards. Edwards al. , Morganella morganii, Vibrio spp., Yersinia spp.), Other gram-negative bacteria (Haemophilus spp., Pseudomonas aeruginosa, Moraxella catarrhalis, Aeromonas spp., Pasteurella multocida, Plesiomonas shigelloides, Campylobacter jejuni spp.); some intracellular pathogens: Legionella pneumophila, Brucella spp., Listeria monocytogenes, Mycobacterium tuberculosis, Mycobacterium kansasii.

Gram-positive aerobic bacteria are also sensitive to ciprofloxacin: Staphylococcus spp. (Staphylococcus aureus, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus), Streptococcus spp. (Streptococcus pyogenes, Streptococcus agalactiae).

The antibiotic is active against Bacillus anthracis.

Most methicillin-resistant staphylococci are also resistant to ciprofloxacin. The sensitivity of Streptococcus pneumoniae, Enterococcus faecalis, Mycobacterium avium (located intracellularly) is moderate (high concentrations are required to suppress them).

Resistant microorganisms: Bacteroides fragilis, Pseudomonas cepacia, Pseudomonas maltophilia, Ureaplasma urealyticum, Clostridium difficile, Nocardia asteroides. The drug is not effective against Treponema pallidum.

Side effects

In rare cases, Cipro can cause side effects: anorexia, nausea, vomiting, abdominal pain, flatulence, diarrhea, cholestatic jaundice (especially in patients with previous liver diseases), hepatitis, hepatonecrosis; dizziness, headache, increased fatigue, anxiety, tremor, insomnia, “nightmares”, peripheral paralgesia (anomaly in the perception of pain), sweating, increased intracranial pressure, confusion, depression, hallucinations, and other manifestations of psychotic reactions.

Very rare side effects: migraine, fainting, cerebral artery thrombosis; disturbances in taste and smell, visual disturbances (diplopia, changes in color perception), tinnitus, hearing loss; tachycardia, heart rhythm disturbances, lengthening of the QT interval, lowering blood pressure; leukopenia, granulocytopenia, anemia, thrombocytopenia, leukocytosis, thrombocytosis, hemolytic anemia; hypoprothrombinemia, increased activity of “liver” transaminases and alkaline phosphatase, hypercreatininemia, hyperbilirubinemia, hyperglycemia; hematuria, crystalluria (primarily with alkaline urine and low urine output), glomerulonephritis, dysuria, polyuria, urinary retention, albuminuria, urethral bleeding, decreased nitrogen excretory function of the kidneys, interstitial nephritis; pruritus, urticaria, blistering with bleeding and small nodules that form scabs, drug fever, punctate hemorrhages on the skin (petechiae), swelling of the face or larynx, dyspnea, eosinophilia, vasculitis, erythema nodosum, exudative, erythema multiforme syndrome – Johnson (malignant exudative erythema), toxic epidermal necrolysis (Lyell’s syndrome); arthralgia, arthritis, tendovaginitis, tendon ruptures, myalgia; general weakness, increased photosensitivity, superinfection (candidiasis, pseudomembranous colitis), face flushing.

How to take Cipro?

The drug is taken orally. Swallow tablets whole with a little liquid after meals. When the tablet is taken on an empty stomach, the active substance is absorbed faster.

• Mild and moderate lower respiratory tract infections – 0.5 g 2 times a day, in severe cases – 0.75 g 2 times. The course of treatment is 7-14 days;
• Acute sinusitis – 0.5 g 2 times a day. The course of treatment is 10 days;
• Infection of the skin and soft tissues of mild and moderate degree – 0.5 g 2 times a day, in case of severe course – 0.75 g 2 times. The course of treatment is 7-14 days;
• Infections of bones and joints – mild and moderate – 0.5 g 2 times a day, in severe cases – 0.75 g 2 times. The course of treatment is up to 4-6 weeks;
• Uncomplicated urinary tract infections – 0.25-0.5 g 2 times a day; the course of treatment is 7-14 days, with complicated urinary tract infections, 0.5 g every 12 hours for 7-14 days;
• Chronic prostatitis – 0.5 g 2 times, the course of treatment is 28 days;
• Uncomplicated gonorrhea – 0.25 g once;
• Acute intestinal infections with a severe course (salmonellosis, shigellosis, campylobacteriosis, etc.) – 0.5 g 2 times, the course of treatment is 5-7 days;
• Typhoid fever – 0.5 g 2 times; the course of treatment is 10 days;
• Complicated intra-abdominal infections – 0.5 g every 12 hours for 7-14 days;
• Prevention and treatment of pulmonary anthrax – 0.5 g 2 times a day for 60 days;
• In patients with immunodeficiency, treatment is prescribed depending on the severity of the infection and the type of pathogen;
• Chronic renal failure: if creatinine clearance (CC) is more than 50 ml / min, dose adjustment is not required; with CC 30-50 ml / min – 0.25-0.5 every 12 hours; with CC 5-29 ml / min – 0.25-0.5 g every 18 hours. If the patient undergoes hemodialysis or peritoneal dialysis – 0.25-0.5 g / day, the drug should be taken after a hemodialysis session;
• Children: pulmonary anthrax (prevention and treatment) – 15 mg / kg 2 times a day. The maximum single dose is 0.5 g, the daily dose is 1 g. The total duration of treatment is 60 days.

Contraindications

Do not take Cipro if you have any of the following conditions:

• hypersensitivity to ciprofloxacin, other fluoroquinolones, auxiliary components of the drug;
• joint use with tizanidine (risk of a pronounced decrease in blood pressure, drowsiness);
• children and adolescents under 18 years of age;
• pregnancy and breastfeeding;
• tendon lesions during previous treatment with fluoroquinolones;
• tendon lesions, including tendovaginitis, tendon rupture, muscle lesions (rhabdomyolysis);
• pseudomembranous colitis.

Pregnancy and breastfeeding

Cipro is contraindicated for use in pregnancy and lactation. The antibiotic crosses the placental barrier, excreted in breast milk. In experimental studies, it has been found that it causes arthropathy.

Overdose

An overdose of ciprofloxacin can cause specific symptoms and increased adverse reactions. Treatment: gastric lavage, intake of emetics, consumption of a large amount of liquid, supportive therapy. There is no specific antidote; During peritoneal dialysis and hemodialysis, only 10% of the drug can be excreted.

Interaction with other drugs

Avoid using Cipro with any of the following drugs:

• theophylline (and other xanthines, such as caffeine);
• oral hypoglycemic drugs;
• indirect anticoagulants;
• other antimicrobial drugs (aminoglycosides, clindamycin, metronidazole);
• mezlocillin, azlocillin and other beta-lactam antibiotics;
• isoxazolyl penicillins and vancomycin;
• cyclosporine;
• iron-containing drugs, sucralfate and antacid drugs containing magnesium, calcium and aluminum salts;
• non-steroidal anti-inflammatory drugs;
• fluoroquinolones;
• uricosuric drugs;
• tizanidine.

Precautions

Cipro is not the drug of choice for suspected or established Streptococcus pneumonia.

In order to avoid crystalluria, it is unacceptable to exceed the recommended daily dose; it is also necessary to have sufficient fluid intake and maintain an acidic urine reaction.

Patients with epilepsy, a history of seizures, vascular diseases and organic brain damage should be prescribed ciprofloxacin only for “vital” indications.

If severe and prolonged diarrhea occurs during or after treatment with ciprofloxacin, the diagnosis of pseudomembranous colitis should be excluded, which requires immediate drug withdrawal.

If pain occurs in the tendons or when the first signs of tendovaginitis appear, treatment should be discontinued.

During the treatment, UV radiation (including contact with direct sunlight) should be avoided.

During treatment, one should refrain from engaging in potentially hazardous activities that require increased attention and speed of mental and motor reactions.